Doctors Rarely Attracted to Rural Clinics

Brown says she likes the small-town setting, which virtually ensures strong doctor-patient relationships.

But she is clearly among a minority. Small salaries, tremendous debt after medical school and the inaccessibility of resources discourage many nurses and physicians from considering anything but city clinics.

"Rural communities frequently suffer from a shortage of physicians because many doctors feel that they cannot sustain a viable practice in a rural setting," said Hilda Heady, president of the National Rural Health Association.

New legislation introduced this week, however, could attract more doctors to communities like those in Colorado. Introduced by Rep. Jim Gibbons, a Nevada Republican, the measure would give a one-time tax credit of $20,000 to physicians who serve at least 350 Medicare patients over two years in a rural health clinic.

"The disparities in the state are getting worse," said Susan Birch, executive director of the Northwest Colorado Visiting Nurse Association. "We absolutely have to incentivize health care providers to come to areas where there is less health care and more challenges."

According to the Colorado Rural Health Council, the federal government found staff shortages in 40 of the 53 rural counties in Colorado in 2002. These chronic shortages only exacerbate the challenges rural communities face, including access to insurance, reliance on Medicaid and lack of transportation to health facilities, according to Denise Denton, director of the Colorado Rural Health Center.

Rep. Marilyn Musgrave, a Republican from the state's eastern plains, supports tax incentives for doctors to serve rural areas, said a spokesman.

An aide for Rep. Mark Udall, D-Colo., said the congressman has taken measures to address the inadequate services, including providing support to a federal program that would train health providers to respond to the needs of special and underserved populations.

Rural communities also find it difficult to pay for hospitals and other services, said Lynn Dierker, deputy director for Community Initiatives at the Colorado Health Institute. Yet care for the elderly is a growing issue in rural communities, she said. Pre-natal care, immunizations and family care also are lacking, Birch said.

The state does have a tax credit available for healthcare professionals to use during the period of their student loan repayment, but according to Denton, those funds are only available when the state has a surplus.

Birch calls for more federal funding and asks that Colorado legislators look at cheap and effective "ways to restore prevention and wellness for everybody." That might be as basic as educating kids about healthy living and providing nutrition and fitness instruction, she said.

Both  Senators Ken Salazar, a Democrat, and Wayne Allard, a Republican, have called on Capitol Hill to pay more attention to rural health needs.

"Rural health care is a critical part of our health care system," Allard said. "Rural Americans shouldn't receive second-rate health care because they are far from a large city."